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  • Title: Ischemia-induced Brugada-type ST-segment alternans and Brugada syndrome.
    Author: Omichi C, Fujimoto N, Kawasaki A, Kasai A.
    Journal: Int J Cardiol; 2010 Oct 29; 144(3):429-30. PubMed ID: 19345432.
    Abstract:
    UNLABELLED: The mechanisms of Brugada-type electrocardiographic (ECG) pattern remain unclear. METHODS: The ST-segment was evaluated during coronary intervention of proximal right coronary artery (RCA). We measured ST-segment elevation with a drug challenge test with a sodium channel blocker. The ST-segment changes were compared with those in true Brugada syndrome. RESULTS: Brugada-type ECG was observed in 6 patients but not in 9 patients during coronary intervention. Five patients demonstrated Brugada-type ST elevation and alternans from coved type to saddleback type during coronary intervention. The patients with ST alternans demonstrated the conus branch occlusion or RV branch occlusion. A drug challenge test developed a significant ST-segment elevation neither in patients with Brugada-type ECG nor in patients without Brugada-type ECG. (0.69±0.48 mv vs. 0.48±0.31 mv, p=NS) There was a significant difference in the ST-segment elevation between patients with Brugada-type ECG during the coronary intervention and patients with true Brugada syndrome (n=5). (0.69±0.48 mv vs. 2.86±0.61 mv, p<0.05). CONCLUSIONS: Ischemia of proximal RCA can masquerade as the Brugada syndrome, ST-segment elevation and alternans. Ischemia of proximal RCA could be one of the different entities showing Brugada-type ECG from true Brugada syndrome.
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